Abstract：
This study aimed to evaluate the risk of endometrial carcinoma and atypical endometrial hyperplasia in asymptomatic postmenopausal women concerning the endometrial thickness measured by stratified threshold categories used for performing subsequent endometrial sampling and histologic evaluation.
MEDLINE, Scopus, ClinicalTrials.gov, SciELO, Embase, the Cochrane Central Register of Controlled Trials, LILACS, conference proceedings, and international controlled trials registries were searched without temporal, geographic, or language restrictions.
Studies were selected if they had a crossover design evaluating the risk of atypical endometrial hyperplasia and endometrial carcinoma in postmenopausal asymptomatic women and calculated the diagnostic accuracy of transvaginal ultrasonography thresholds (at least 3.0 mm) confirmed by histopathologic diagnosis.
This was a systematic review and diagnostic test accuracy meta-analysis according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses of Diagnostic Test Accuracy and Synthesizing Evidence from Diagnostic Accuracy Tests guidelines. Endometrial thickness thresholds were grouped as follows: from 3.0 to 5.9 mm; between 6.0 and 9.9 mm; between 10.0 and 13.9 mm; and ≥14.0 mm. Quality assessment was performed using the Quality Assessment Tool for Diagnostic Accuracy Studies 2 tool. Publication bias was quantified using the Deek funnel plot test. Coprimary outcomes were the risk of atypical endometrial hyperplasia or endometrial carcinoma according to the endometrial thickness and diagnostic accuracy of each threshold group.
A total of 18 studies provided the data of 10,334 women who were all included in the final analysis. Overall, at an endometrial thickness threshold of at least 3.0 mm, the risk of atypical endometrial hyperplasia or endometrial carcinoma was increased 3-fold relative to women below the cutoff (relative risk, 3.77; 95% confidence interval, 2.26-6.32; I2=74%). Similar degrees of risk were reported for thresholds between 3.0 and 5.9 mm (relative risk, 5.08; 95% confidence interval, 2.26-11.41; I2=0%), 6.0 and 9.9 mm (relative risk, 4.34; 95% confidence interval, 1.68-11.23; I2=0%), 10.0 and 13.9 mm (relative risk, 4.11; 95% confidence interval, 1.55-10.87; I2=86%), and ≥14.0 mm (relative risk, 2.53; 95% confidence interval, 1.04-6.16; I2=78%) with no significant difference among subgroups (P=.885). Regarding diagnostic accuracy, the pooled sensitivity decreased from thresholds below 5.9 mm (relative risk, 0.81; 95% confidence interval, 0.49-0.85) to above 14.0 mm (relative risk, 0.28; 95% confidence interval, 0.18-0.40). Furthermore, the specificity increased from 0.70 (95% confidence interval, 0.61-0.78) for endometrial thickness between 3.0 and 5.9 mm to 0.86 (95% confidence interval, 0.71-0.94) when the endometrial thickness is ≥14.0 mm. For 3.0 to 5.9 mm and 10.0 to 13.9 mm thresholds, the highest diagnostic odds ratios of 10 (95% confidence interval, 3-41) and 11 (95% confidence interval, 2-49), with areas under the curve of 0.81 (95% confidence interval, 0.77-0.84) and 0.82 (95% confidence interval, 0.79-0.86), respectively, were retrieved. The summary point analysis revealed that the 3.0 to 5.9 mm cutoff point was placed higher in the summary receiver operator curve space than the other subgroups, indicating increased endometrial carcinoma or atypical endometrial hyperplasia diagnosis using these cutoffs.
Both low and high endometrial thickness thresholds in postmenopausal asymptomatic women seem equally effective in detecting endometrial carcinoma and atypical endometrial hyperplasia. However, although using a 3.0 to 5.9 mm cutoff results in a lower specificity, the offsetting improvement in sensitivity may justify using this cutoff for further endometrial evaluation in patients with suspected endometrial malignancy.
MEDLINE, Scopus, ClinicalTrials.gov, SciELO, Embase, the Cochrane Central Register of Controlled Trials, LILACS, conference proceedings, and international controlled trials registries were searched without temporal, geographic, or language restrictions.
Studies were selected if they had a crossover design evaluating the risk of atypical endometrial hyperplasia and endometrial carcinoma in postmenopausal asymptomatic women and calculated the diagnostic accuracy of transvaginal ultrasonography thresholds (at least 3.0 mm) confirmed by histopathologic diagnosis.
This was a systematic review and diagnostic test accuracy meta-analysis according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses of Diagnostic Test Accuracy and Synthesizing Evidence from Diagnostic Accuracy Tests guidelines. Endometrial thickness thresholds were grouped as follows: from 3.0 to 5.9 mm; between 6.0 and 9.9 mm; between 10.0 and 13.9 mm; and ≥14.0 mm. Quality assessment was performed using the Quality Assessment Tool for Diagnostic Accuracy Studies 2 tool. Publication bias was quantified using the Deek funnel plot test. Coprimary outcomes were the risk of atypical endometrial hyperplasia or endometrial carcinoma according to the endometrial thickness and diagnostic accuracy of each threshold group.
A total of 18 studies provided the data of 10,334 women who were all included in the final analysis. Overall, at an endometrial thickness threshold of at least 3.0 mm, the risk of atypical endometrial hyperplasia or endometrial carcinoma was increased 3-fold relative to women below the cutoff (relative risk, 3.77; 95% confidence interval, 2.26-6.32; I2=74%). Similar degrees of risk were reported for thresholds between 3.0 and 5.9 mm (relative risk, 5.08; 95% confidence interval, 2.26-11.41; I2=0%), 6.0 and 9.9 mm (relative risk, 4.34; 95% confidence interval, 1.68-11.23; I2=0%), 10.0 and 13.9 mm (relative risk, 4.11; 95% confidence interval, 1.55-10.87; I2=86%), and ≥14.0 mm (relative risk, 2.53; 95% confidence interval, 1.04-6.16; I2=78%) with no significant difference among subgroups (P=.885). Regarding diagnostic accuracy, the pooled sensitivity decreased from thresholds below 5.9 mm (relative risk, 0.81; 95% confidence interval, 0.49-0.85) to above 14.0 mm (relative risk, 0.28; 95% confidence interval, 0.18-0.40). Furthermore, the specificity increased from 0.70 (95% confidence interval, 0.61-0.78) for endometrial thickness between 3.0 and 5.9 mm to 0.86 (95% confidence interval, 0.71-0.94) when the endometrial thickness is ≥14.0 mm. For 3.0 to 5.9 mm and 10.0 to 13.9 mm thresholds, the highest diagnostic odds ratios of 10 (95% confidence interval, 3-41) and 11 (95% confidence interval, 2-49), with areas under the curve of 0.81 (95% confidence interval, 0.77-0.84) and 0.82 (95% confidence interval, 0.79-0.86), respectively, were retrieved. The summary point analysis revealed that the 3.0 to 5.9 mm cutoff point was placed higher in the summary receiver operator curve space than the other subgroups, indicating increased endometrial carcinoma or atypical endometrial hyperplasia diagnosis using these cutoffs.
Both low and high endometrial thickness thresholds in postmenopausal asymptomatic women seem equally effective in detecting endometrial carcinoma and atypical endometrial hyperplasia. However, although using a 3.0 to 5.9 mm cutoff results in a lower specificity, the offsetting improvement in sensitivity may justify using this cutoff for further endometrial evaluation in patients with suspected endometrial malignancy.
摘要：
目的：本研究旨在评估无症状的绝经后妇女子宫内膜癌和不典型子宫内膜增生的风险，并通过分层阈值类别测量子宫内膜厚度，用于随后的子宫内膜取样和组织学评估。
方法：MEDLINE，Scopus,ClinicalTrials.gov,SciELO,Embase,Cochrane中央受控试验登记册,LILACS,会议记录,国际对照试验登记处的搜索没有时间，地理,或语言限制。
方法：选择具有交叉设计的研究，评估绝经后无症状妇女非典型子宫内膜增生和子宫内膜癌的风险，并计算经组织病理学诊断证实的经阴道超声检查阈值（至少3.0mm）的诊断准确性。
方法：这是一项系统评价和诊断测试准确性荟萃分析，是根据诊断测试准确性的系统评价和荟萃分析的首选报告项目进行的。子宫内膜厚度阈值分组如下：3.0至5.9mm；6.0至9.9mm；10.0至13.9mm；≥14.0mm。使用诊断准确性研究2工具的质量评估工具进行质量评估。使用Deek漏斗图检验量化发布偏差。根据每个阈值组的子宫内膜厚度和诊断准确性，共同结局是非典型子宫内膜增生或子宫内膜癌的风险。
结果：共有18项研究提供了10,334名女性的数据，这些女性都被纳入了最终分析。总的来说,在子宫内膜厚度阈值至少为3.0mm时，非典型子宫内膜增生或子宫内膜癌的风险比低于临界值的女性增加3倍（相对风险，3.77；95%置信区间，2.26-6.32；I2=74%）。对于3.0至5.9毫米之间的阈值，报告的风险程度相似(相对风险，5.08；95%置信区间，2.26-11.41；I2=0%），6.0和9.9毫米(相对风险，4.34；95%置信区间，1.68-11.23；I2=0%），10.0和13.9毫米(相对风险，4.11；95%置信区间，1.55-10.87；I2=86%），且≥14.0mm(相对风险，2.53；95%置信区间，1.04-6.16；I2=78％），亚组之间无显着差异（P=.885）。关于诊断准确性，合并敏感性从低于5.9毫米的阈值降低(相对风险，0.81；95%置信区间，0.49-0.85)至14.0毫米以上(相对风险，0.28；95%置信区间，0.18-0.40）。此外，特异性从0.70增加(95%置信区间，0.61-0.78）对于3.0至5.9mm至0.86之间的子宫内膜厚度（95％置信区间，0.71-0.94）当子宫内膜厚度≥14.0mm时。对于3.0至5.9mm和10.0至13.9mm的阈值，最高的诊断赔率比为10(95%置信区间，3-41)和11(95%置信区间，2-49),曲线下面积为0.81(95%置信区间，0.77-0.84)和0.82(95%置信区间，0.79-0.86),分别,被检索。汇总点分析显示，3.0至5.9mm的截止点在汇总接收器操作员曲线空间中的位置高于其他子组，使用这些截止值表明子宫内膜癌增加或非典型子宫内膜增生诊断。
结论：绝经后无症状妇女的低子宫内膜厚度阈值和高子宫内膜厚度阈值在检测子宫内膜癌和不典型子宫内膜增生方面似乎同样有效。然而,尽管使用3.0至5.9mm的截止值会导致较低的特异性，在疑似子宫内膜恶性肿瘤的患者中,敏感性的抵消性改善可能证明将该截止值用于进一步的子宫内膜评估.
方法：MEDLINE，Scopus,ClinicalTrials.gov,SciELO,Embase,Cochrane中央受控试验登记册,LILACS,会议记录,国际对照试验登记处的搜索没有时间，地理,或语言限制。
方法：选择具有交叉设计的研究，评估绝经后无症状妇女非典型子宫内膜增生和子宫内膜癌的风险，并计算经组织病理学诊断证实的经阴道超声检查阈值（至少3.0mm）的诊断准确性。
方法：这是一项系统评价和诊断测试准确性荟萃分析，是根据诊断测试准确性的系统评价和荟萃分析的首选报告项目进行的。子宫内膜厚度阈值分组如下：3.0至5.9mm；6.0至9.9mm；10.0至13.9mm；≥14.0mm。使用诊断准确性研究2工具的质量评估工具进行质量评估。使用Deek漏斗图检验量化发布偏差。根据每个阈值组的子宫内膜厚度和诊断准确性，共同结局是非典型子宫内膜增生或子宫内膜癌的风险。
结果：共有18项研究提供了10,334名女性的数据，这些女性都被纳入了最终分析。总的来说,在子宫内膜厚度阈值至少为3.0mm时，非典型子宫内膜增生或子宫内膜癌的风险比低于临界值的女性增加3倍（相对风险，3.77；95%置信区间，2.26-6.32；I2=74%）。对于3.0至5.9毫米之间的阈值，报告的风险程度相似(相对风险，5.08；95%置信区间，2.26-11.41；I2=0%），6.0和9.9毫米(相对风险，4.34；95%置信区间，1.68-11.23；I2=0%），10.0和13.9毫米(相对风险，4.11；95%置信区间，1.55-10.87；I2=86%），且≥14.0mm(相对风险，2.53；95%置信区间，1.04-6.16；I2=78％），亚组之间无显着差异（P=.885）。关于诊断准确性，合并敏感性从低于5.9毫米的阈值降低(相对风险，0.81；95%置信区间，0.49-0.85)至14.0毫米以上(相对风险，0.28；95%置信区间，0.18-0.40）。此外，特异性从0.70增加(95%置信区间，0.61-0.78）对于3.0至5.9mm至0.86之间的子宫内膜厚度（95％置信区间，0.71-0.94）当子宫内膜厚度≥14.0mm时。对于3.0至5.9mm和10.0至13.9mm的阈值，最高的诊断赔率比为10(95%置信区间，3-41)和11(95%置信区间，2-49),曲线下面积为0.81(95%置信区间，0.77-0.84)和0.82(95%置信区间，0.79-0.86),分别,被检索。汇总点分析显示，3.0至5.9mm的截止点在汇总接收器操作员曲线空间中的位置高于其他子组，使用这些截止值表明子宫内膜癌增加或非典型子宫内膜增生诊断。
结论：绝经后无症状妇女的低子宫内膜厚度阈值和高子宫内膜厚度阈值在检测子宫内膜癌和不典型子宫内膜增生方面似乎同样有效。然而,尽管使用3.0至5.9mm的截止值会导致较低的特异性，在疑似子宫内膜恶性肿瘤的患者中,敏感性的抵消性改善可能证明将该截止值用于进一步的子宫内膜评估.
